Friday, February 09, 2007

The Search for the Magic Bullet

"I can't sleep. I sleep maybe four hours every night. If I go to bed at midnight, I get up at four. If I go to bed at four I get up at seven. It's crazy." She rolls her eyes in disgust.

"Well, there's a program we can send you to where they teach you how to sleep better," the kindly doctor says. "It's called sleep hygeine."

"It works for alot of people," I add. "Medications often don't do enough."

"No way," she replies vehemently. "I know my body, I know my brain. I just can't sleep. All I need is a pill to make me sleep." She crosses her arms. The doctor and I exchange glances.

"What do you do when you can't sleep?" He looks at her and then at me.

"Watch TV."

"You watch TV. Anything else?" I ask.

"Oh yeah, I smoke." There's silence in the room.

"How about your back?" the doc asks, changing the subject. "Is that any better?"

"Nah," she retorts. "It's worse. Hurts all the time. If I sit it's OK, otherwise it's torture. The muscle relaxants don't help either."

"How about the methadone?" the doctor asks. (The patient is on methadone three times a day for chronic pain.)

"No, it doesn't help at all. Can I get something else?" She crosses her arms again.

"We'd like to try physical therapy."

"I won't do that! That hurts! My friend says it messed her up!"

The doctor and I smile. "We can direct them regarding what they do. There's massage, cold and heat packs, ultrasound. You might really like it."

"I won't stretch! I know my body. I know that stretching hurts. I just want a pill."

The appointment's going nowhere, and we haven't even talked about her Hepatitis C treatment yet. We're both exasperated. No sleeping pill prescription is forthcoming, and she eventually concedes to a physical therapy referral. Will she go? Probably not.

Everyone wants the magic bullet, a pill to assuage their suffering. Many doctors use that arsenal of pharmacoepia to attempt to do just that, but sometimes we just want some proactive work to be done by the patient, some effort beyond opening a bottle and swallowing a pill. Sure, sleep hygeine education isn't anyone's idea of a good time, but what good is a pill when the patient has no inkling of how to properly prepare for a good night's sleep? We frequently dance along the edge of enabling such passive behavior. Of course we may give in at times, but sometimes we just say no to the easy way out.
Post a Comment